Is Number Ten so defensive over the NHS that it has forgotten how to attack? (As, over Mid-Staffs, it should.)

Tony Blair swooped on a cowed Conservative front bench with all the histrionic skill and focused outrage at his disposal. In the same horrified tones that he had used to respond to the heart-breaking murder of Jamie Bulger, he read details of deaths to gasps of horror from Labour MPs. The breast cancer
sufferer found by her husband crying and alone, surrounded in blood and
urine...the 95-year-old
woman with diarrhoea, vomiting and water leaking from her swollen legs, who
lay unexamined by a doctor for four days...the woman who was told to “toilet in her bed”, and discovered a male
patient sleeping across her legs.

"And all this happened," the Prime Minister concluded, glancing down at Alastair Campbell's script, "on the watch of a party who told us that the NHS was safe in their hands." His Deputy plunged the knife in even more directly: "It proves what we've always said," John Prescott said on Question Time that evening, before deploying a classic Labour attack line: "You can't trust the Tories on the NHS". Downing Street clung on to the isolated NHS Chief Executive just long enough to ensure that the media's wrath had reached boiling-point - it commissioned a swift inquiry - before sacking him in as brutal and humiliating a manner as possible. "Blair sacks angel of death," screamed the Mirror.

The New Labour spin machine had waited long enough to draw four former Conservative Health Secretaries into the fray. Ken Clarke, William Waldegrave, Virginia Bottomley and Stephen Dorrell all protested that the Chief Executive had been carrying out vital reforming work for the health service. The campaign against him was "grossly unfair", said Clarke. Waldegrave pointed out that "the easiest thing is to always look for the kneejerk response". Bottomley argued that "the report didn't say that anybody knowingly ignored warnings". Number Ten's ruthless and exploitative strategy threw the Tory front bench into disarray, as panicking backbenchers began to denonce the former health secretaries...

I don't like having to borrow the names of four excellent and dedicated former Ministers to make a point. None the less, I think it holds. It does Downing Street credit that it is more fair-minded than in Blair's day. (Not that its motives are all dispassionate: the Government seems to want to keep David Nicholson to help ensure that the "Nicholson Challenge" is met.) And when it does start hunting for scapegoats, the results are a sorry spectacle: consider the stripping of Fred Goodwin's knighthood, which set a disturbing precedent. But Steve Barclay in today's Telegraph and Sarah Wollaston in the same paper yesterday were right: Mid-Staffs showed systemic failure, for which the man at the top - who's still in charge - should be held responsible.

If this means targetting public outrage on Labour - whose box-ticking, target-chasing culture helped to shape the Mid-Staffs horror - this seems reasonable enough. Ask around about senior Tories in government, and you'll find that view is widely shared. (Though Jeremy Hunt is helping to lead the way, aiming, as Tim Montgomerie has put it, "to be angrier at the failings of the NHS than any patient". Is Number Ten so used to being thrown on the defensive by Labour, especially on health, that it simply can't conceive of going - rightly, in this case - on the attack?